Spinal injuries with tetraplegia and paraplegia.

Although the actual management is vital for success, the institution in which spinal injuries are cared for shares equally in importance. When responsibility is accepted by a multidisciplinary team, better restoration of function occurs whilst greater social and financial support is possible. The piecemeal care of spinal fractures with paralysis (Morgan, Wharton and Austin 1 97 1 ; Botterell et a!. 1 975 ; Sussman 1 978) is a practice endemic in every community and to be condemned. The creation of comprehensive units (Fig. 1) served by all specialties but co-ordinated by one-an emergent discipline-has allowed solution of fragm entary care (Guttmann 1977a, 1978; Botterell 1978) and has seen the emergence of new talents in seriously injured people (Guttmann 1968). Covalt et al. (1953) and Talbot (1969) showed